Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006.
OBJECTIVE
This study investigated length of stay, readmission rates, and postoperative mortality in adult patients undergoing traditional and laparoscopic appendectomy in England between April 1, 1996, and March 31, 2006.


METHODS
All procedures coded to the "H01-Emergency Excision of Appendix" procedure code in the Hospital Episode Statistics database were included. Multivariate analyses were used to identify independent predictors of length of hospital stay, 30-day and 365-day mortality.


RESULTS
A total of 259,735 procedures were assigned to the H01-Emergency excision of appendix OPCS-4 3-digit code procedure between 1996 and 2006. A laparoscopic technique was employed in 16,315 (6.3%). A greater proportion of deaths occurred in hospital within 30 days of "open" appendectomy surgery (0.25%) compared with procedures utilizing a laparoscopic technique (0.09%, P < 0.001). One-year mortality rates, measured over a 5-year period, were also higher after open surgery (0.64% vs. 0.29%, P < 0.001). Multiple logistic regressions demonstrated that an open operative technique, older age, male gender, and increasing comorbidity were strong independent determinants of early and 1-year postoperative mortality after emergency appendectomy. The duration of stay for patients undergoing open emergency appendectomy exceeded that for patients undergoing the laparoscopic technique (P < 0.001). Patients undergoing a laparoscopic technique were, however, more likely to be readmitted within 28 days of surgery (7.10% vs. 4.95%, P < 0.001).


CONCLUSIONS
Laparoscopic appendectomy is safe and associated with lower postoperative mortality rates than open procedures. The cost implications are uncertain as this technique is associated with shorter hospital stay but higher subsequent readmission rates.
Faiz
Omar
O
Department of Colorectal surgery, St. Mark's Hospital, Harrow, Middlesex, UK. omarfaiz@aol.com
Clark
Jeremy
J
Brown
Tim
T
Bottle
Alex
A
Antoniou
Anthony
A
Farrands
Paul
P
Darzi
Ara
A
Aylin
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000401:mortality / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013222:State Medicine